Colorado Medicaid FAQ

Q. How can I tell if my Medicaid effective?
A. By visiting the Colorado PEAK website and clicking on Check My Benefits, you can determine whether your Medicaid benefits are in effect. Additionally, you may contact a nearby County Department of Social/Human Services office, or call Medicaid Customer Service at 303-866-3513 (Denver metro area), or 800-221-3943 (outside Denver area).

Q. I misplaced my Medicaid ID card. How can I get it replaced?
A. Contact your local County Department of Social/Human Services for a new Medical Identification Card (MIC).

Q. I’m unable to obtain my prescription medication through Medicaid. Is there anyone I can contact to help?
A. To clarify coverage details and information about prescriptions, call Customer Service at 303-866-3513 if you live in the Denver area, or 800-221-3943 for Colorado residents outside the 303 area code.

Q. I may have to visit the emergency room, though I’m not sure if it’s necessary. Is there anyone I can consult before going?
A. Contact the NURSE ADVICE LINE at 800-283-3221.

Q. How can I change my personal information or notify Medicaid I have given birth and need my child insured?
A. Contact your local County Department of Social/Human Services.

Q. I am a dual enrollee of Medicaid and Medicare. Will Medicaid help cover my prescription costs for Medicare?
A. Not necessarily. Medicaid is the payer of last resort, or in other words, Medicaid pays last if you have other coverage. Those with additional health insurance, including Medicare Part D prescription drug benefit, will most likely have their prescriptions covered by Medicare. Only in very rare cases are there medications which Part D does not cover and Medicaid does.

Q. Why am I signed up for a Medicaid HMO? What is the purpose of managed care in Medicaid?
A. Managed care helps Medicaid members connect with a trusted HMO network and a primary care provider to coordinate your care. An HMO is the network through which you are able to access providers and services, most of which will require authorization from your doctor first. To find out more about Medicaid HMOs, contact HealthColorado, the Medicaid enrollment broker, at 303-839-2120 (in Denver area), or 888-367-6557 (outside Denver area).

Q. How do I cancel enrollment in the HMO but keep Medicaid coverage?
A. Contact HealthColorado at 303-839-2120 for residents of Metro Denver, or 888-367-6557 if you live outside the Denver area.

Q. How can I receive direction in selecting my primary care doctor?
A. Contact HealthColorado at 303-839-2120 if you live in the Denver area, or 888-367-6557 for Coloradans living outside Metro Denver.

Q. Where can I located a list of Medicaid Specialists?
A. Use the Medicaid Provider Lookup tool, or contact Customer Service at 303-866-3513 or 800-221-3943.

Q. I received a bill from a provider. How should I handle this?
A. Call the provider from which you receive the bill first, and ask why they have sent you a bill and obtain all the information you are able to. After you speak with the provider’s office, contact Customer Service at 303-866-3513 or 800-221-3943.

Q. If I leave the state while traveling and end up needing care, what protections do I have, if any?
A. When you leave the state for a short period of time and are still a resident of Colorado, you may receive some Medicaid benefits in specific circumstances:

  1. A medical emergency that is life- or limb-threatening, according to a doctor’s diagnosis.
  2. If you had to return to Colorado to receive treatment first, your health would be endangered.
  3. The Out-of-State provider will be reimbursed only if they participate in or will consider participation in Colorado Medicaid.